Divine Residential Services, LLC
Community Based Residential Treatment Facility, Mental Illness in Richmond, VA. Organization (NPI-2).
NPI number1114101342
StatusActive
Last updated in NPPESDec 24, 2007
Details
- NPI
- 1114101342
- Entity type
- Organization (NPI-2)
- Legal business name
- Divine Residential Services, LLC
- Organization subpart
- No
- Enumeration date
- Dec 24, 2007
- Last updated
- Dec 24, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | 89305001 | VA | Yes |
Practice location
6206 Manuel CtRichmond, VA 23234-5894
Phone 804-918-1433
Mailing address
12501 Chesdin Landing DrChesterfield, VA 23838-3230
Phone 804-306-1242
Authorized official
Samara T Gracia
Executive Director
8043061242
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